While the real culprits of the Gorakhpur deaths will soon be identified, the need today is to prevent similar incidents in any other hospital across the country.By Dr S Gurushankar

The death of more than 60 children at Gorakhpur’s state-run BRD Medical College and Hospital, apparently due to inadequate oxygen supply, made the entire country sit up and take notice. Even one death of a child due to medical negligence and irresponsibility is one too many. The needless tragedy should serve as a wake-up call for both central and state governments to usher in radical reforms of the public health system.

It is well-known that India’s state-run hospitals are overburdened, understaffed and underfunded, suffering from a chronic shortage of medicines, beds and supplies, even as doctors are overwhelmed with a crush of patients. When this situation gets layered with a culture of unaccountability, lack of transparency, corruption, dereliction of duty and lax supervision, tragedies become inevitable.

While the real culprits of the Gorakhpur deaths will soon be identified, the need today is to prevent similar incidents in any other hospital across the country. Usually when such mishaps occur, no one steps forward to take responsibility and hold oneself accountable for what went wrong. Yet, in the interest of justice, the buck needs to stop somewhere. To me, the responsibility at each layer of the healthcare system is clear cut.

As the biggest stakeholder in public health, the government must take ownership of problem. The Union health minister must be held accountable if diseases like the Japanese encephalitis spread to other parts of the country. The Union finance minister must raise the country’s health budget in tune with the National Health Policy – healthcare should no longer be starved of funds.

State governments must not lag in declaring health alerts in time in their respective states. They should take responsibility to ensure timely payments to hospital vendors. They need to ensure that adequate number of ICU beds, ventilators and other health facilities are available for the people. The state health and finance ministers should not reimburse amounts to hospitals that are much lower than the actual cost of treatment, under any state health insurance scheme. They should be held accountable when such payments are delayed for months, as this badly affects the system and quality of care. The central government should be accountable for delayed payments by CGHS, PSUs, and insurance companies.

Governments must initiate periodic reviews of the overall functioning of state-run hospitals. Service contract doctors must be held accountable if they divert patients to their private practice. Likewise, service regular doctors must be penalized if they take up private practice despite benefitting from the Non Practising Allowance (NPA). Government hospitals must not be allowed to divert every serious patient to empanelled hospitals. The health minister must accept responsibility to promptly fill vacancies in these institutions. Vacant posts are one of the prime reasons for low quality of care. The riot act must also be read to corporate hospitals which refuse poor patents without first stabilizing them.

Finally, every citizen – the people, the government, the medical fraternity – should accept responsibility for preventable deaths that continue to happen, like in Gorakhpur. The media has a key role to play in driving awareness about the need for accountability in the public healthcare system.

In most nations in the West, and even in some neighbouring countries like Sri Lanka, government hospitals form the backbone of the national healthcare system, catering to bulk of the patients. But in India, state-run hospitals are mostly avoided by people, patronized only by those who lack the means to afford the much more efficiently run private sector.

It is therefore a travesty that the Government, instead of focusing on improving the quality of care in state-run hospitals, is currently occupied with controlling the billing costs in private hospitals. Worse, it is attempting to do so with a sledgehammer approach, without analysing the costs these hospitals incur on various medical procedures. For example, in Tamil Nadu, the Government wants private hospitals to do procedures under the CM insurance scheme for an unreasonable price.

We need to appreciate that quality comes at a cost. While in Government hospitals, patient treatment can be subsidized with tax payer’s money, private hospitals do not have this luxury. Rather than imposing unreasonable restrictions on how much they can charge for each procedure, the Government should instead focus on increasing the efficiencies of public hospitals, which are in dire need of such improvements, as shown by the Gorakhpur tragedy.

With immense pride “India Live” celebrated its 10th national conference in Mumbai from 28th February to 3rd March 2019. The conference turned out to be a gold mine of information, with emphasis on academics, education and exchange of knowledge with leaders in interventional cardiology from both India and abroad.